255 data are provided in excellent tabular form, is too lengthy for adequate summary. Agriculture, as always, presents a favourable picture. Coal-mining is extensively considered, both with regard to work done and to coal-field. The coal-miner appears to have benefited in the last ten years less than others, but his mortality is still favourable. Again Lancashire followed by South Wales is found with higher mortality than other coal-fields, but the difference is less than in 1910-12. Special attention is paid throughout to manifestations of recognised risks, such as dust among tin-miners and iron-miners, stone- masons and potters, cotton-strippers and others ; and intense heat among gas-stokers, puddlers, and glass- workers. The new figures relating to fertility again show birth-rate increasing from the highest to the lowest in the social scale, a characteristic pheno- menon of our own generation. Infant mortality is found highest where the birth-rate is highest, but it has fallen remarkably for all grades of the com- munity in recent years, and now varies from only 38 for Class 1. to 97 for Class V. MEDICINE AND THE LAW. Illegal Operation: Verdict of Manslaughter. ON Jan. 27th Charles Jackson Palmer, aged 59, described as a medical electrician, was found guilty at the Central Criminal Court of the manslaughter of Mrs. Goldsmith, a young woman of 21, who had gone to his consulting-room in Upper Brook-street for treatment on returning from her honeymoon. The prosecution alleged that her death was due to the unlawful injection of a fluid made up of soap and water, injected for the sole purpose of procuring abortion. The accused stated that the deceased came to him for electrical treatment for anaemia, and nervous debility ; he denied that he knew that Mrs. Goldsmith was pregnant; he said he was giving her electrical treatment when she suddenly sat up, clenched her hands, and collapsed. He told the police inspector that the treatment consisted of placing a pad down the spine and inducing an alternating current through the body in the region of the abdomen. Dr. H. B. Weir, who made the post- mortem examination, said the deceased was a perfectly healthy woman. On opening a portion of the body a soapy fluid began to escape ; he saw something suggesting a slight abrasion. Sir Bernard Spilsbury said the fluid was a strong solution of soap and water ; he drew the conclusion that the abrasion was produced by the nozzle of a syringe a few minutes before death. Both these witnesses were of opinion that the cause of death was shock due to an injection of fluid. The defence sought to discount these opinions and claimed that the evidence was consistent with the view that death was the result of electric shock ; if there was soapy water in the body, the dead woman had perhaps placed it there herself. After the jury had found the accused guilty, the Lord Chief Justice described the conviction as based on evidence so clear as to be quite overwhelming ; it " approached the certainty of mathematical demonstration." A police inspector reported that there was no previous conviction against the defendant ; for some years he had conducted a genuine medical electrician’s business among well-to-do people, but during the past 15 months the police had received information suggesting that he had been a party to illegal opera- tions ; his premises had on that account been frequently visited by inspectors. Lord Hewart asked questions during the case as to the by-laws made by the London County Council under its General Powers Act of 1920 for regulation of massage I and special treatment establishments. These appear to contain valuable provisions, but it is for considera- tion whether some further and more vigilant measure is not possible to restrict the conduct of premises like those of Palmer as a place where criminal abortion can be practiced with such appalling results. On Jan. 31st Lord Hewart passed a sentence of seven years penal servitude and ordered Palmer to pay the costs of the prosecution. Persons, said the Lord Chief Justice, to whom clients resort for the purpose of illegal operations, undoubtedly subject those clients to very grave risks ; "it is right that all of them, wherever they may be in this country, should understand that they incur grave risks themselves." Pasteurised Mil7L. In 1922 Parliament forbade the offer for sale and the advertisement or description of milk as " pasteur- ised milk," except under licence given by the Minister of Health or granted with his authority under a. statutory order. Licences could be granted on terms and conditions prescribed by such order. The subse- quent Milk (Special Designations) Order of 1923 dealt inter alia with pasteurised milk and enacted as one of the conditions that, on a sample taken after pasteurisa- tion and before delivery to the customer, the milk should be found to contain (in samples taken after the year 1923) not more than 100,000 bacteria per cubic centimetre. Our contemporary, the Medical Officer, reports what is perhaps the first of the prose- cutions for breach of this condition. A Wandsworth firm was prosecuted at the Kensington Petty Sessions. for selling " pasteurised " milk not of the stipulated statutory standard, a sample (submitted to the Clinical Research Association) having shown bacteria to the number of 323,333 per cubic centimetre. It was stated for the prosecution that two other samples taken might equally have formed the subject of proceedings, and that the lids of the churns from which the samples were taken did not satisfactorily exclude rain and dust. The magistrates found the offences proved and fined the defendant firm (which had not appeared) 25 and £ 10 10s. costs. There was a second summons on which a further fine of £ 3 was imposed. This was for selling in Kensington without a Kensing- ton licence in breach of a condition specified in the licence. The firm had a, Wandsworth licence for selling pasteurised milk, but this did not authorise sale outside the Wandsworth area except by way of wholesale distribution. Death from Borax Poisoning. Recently at an inquest at Luton on the death of an infant, IS days old, Dr. J. Birch stated that the post- mortem examination showed death to be due to borax poisoning. The symptoms, he said, could have arisen from the use of honey and borax or glycerine and borax, a jar of which was produced in court. Dr. Birch criticised the use of this substance as dangerous. especially when dispensed as a remedy for thrush- usually administered by smearing it on the gums of the infant. He stated that a quarter of the amount- given to this baby had been known to be fatal to adults. He had known the danger of this preparation all his professional life and had always forbidden its. use. He considered it ought not to be given in the British Pharmacopoeia in its present strength. Injury Caused by Hair-dye. Actions are not infrequently brought against hair- dressers for damages for dermatitis caused by the application of hair-dye. They are based upon allegations that the hairdresser has been negligent, or alternatively upon breach of contract and warranty. - Such an action was lately brought against, an Oxford-street hairdresser who appears to have employed a dye containing 30 per cent. of para- phenylene diamine. His practice was to exhibit a printed notice disclaiming liability for the ill-effects of his hair-dyes ; the notice stated that about two persons in a thousand suffer ill-effects ; "as it is impossible to know these few without a test, we are willing to give this free trial on the customer’s own responsibility." The plaintiff, who wanted her hair dved blue-black like that of a friend of hers who had recently been so treated, was given a preliminary test. Dye was applied to a patch of skin behind the ear-
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data are provided in excellent tabular form, is toolengthy for adequate summary. Agriculture, as
always, presents a favourable picture. Coal-mining isextensively considered, both with regard to work doneand to coal-field. The coal-miner appears to havebenefited in the last ten years less than others, but hismortality is still favourable. Again Lancashirefollowed by South Wales is found with highermortality than other coal-fields, but the difference isless than in 1910-12. Special attention is paidthroughout to manifestations of recognised risks, suchas dust among tin-miners and iron-miners, stone-masons and potters, cotton-strippers and others ; andintense heat among gas-stokers, puddlers, and glass-workers. The new figures relating to fertility againshow birth-rate increasing from the highest to thelowest in the social scale, a characteristic pheno-menon of our own generation. Infant mortality isfound highest where the birth-rate is highest, butit has fallen remarkably for all grades of the com-munity in recent years, and now varies from only38 for Class 1. to 97 for Class V.
MEDICINE AND THE LAW.
Illegal Operation: Verdict of Manslaughter.ON Jan. 27th Charles Jackson Palmer, aged 59,
described as a medical electrician, was found guiltyat the Central Criminal Court of the manslaughterof Mrs. Goldsmith, a young woman of 21, who hadgone to his consulting-room in Upper Brook-streetfor treatment on returning from her honeymoon.The prosecution alleged that her death was due to theunlawful injection of a fluid made up of soap andwater, injected for the sole purpose of procuringabortion. The accused stated that the deceased cameto him for electrical treatment for anaemia, andnervous debility ; he denied that he knew that Mrs.Goldsmith was pregnant; he said he was giving herelectrical treatment when she suddenly sat up,clenched her hands, and collapsed. He told thepolice inspector that the treatment consisted ofplacing a pad down the spine and inducing analternating current through the body in the region ofthe abdomen. Dr. H. B. Weir, who made the post-mortem examination, said the deceased was a
perfectly healthy woman. On opening a portion ofthe body a soapy fluid began to escape ; he sawsomething suggesting a slight abrasion. Sir BernardSpilsbury said the fluid was a strong solution of soapand water ; he drew the conclusion that the abrasionwas produced by the nozzle of a syringe a few minutesbefore death. Both these witnesses were of opinionthat the cause of death was shock due to an injectionof fluid. The defence sought to discount theseopinions and claimed that the evidence was consistentwith the view that death was the result of electricshock ; if there was soapy water in the body, the deadwoman had perhaps placed it there herself. Afterthe jury had found the accused guilty, the Lord ChiefJustice described the conviction as based on evidenceso clear as to be quite overwhelming ; it " approachedthe certainty of mathematical demonstration." Apolice inspector reported that there was no previousconviction against the defendant ; for some years hehad conducted a genuine medical electrician’s businessamong well-to-do people, but during the past15 months the police had received informationsuggesting that he had been a party to illegal opera-tions ; his premises had on that account beenfrequently visited by inspectors. Lord Hewartasked questions during the case as to the by-lawsmade by the London County Council under itsGeneral Powers Act of 1920 for regulation of massage Iand special treatment establishments. These appearto contain valuable provisions, but it is for considera-tion whether some further and more vigilant measureis not possible to restrict the conduct of premiseslike those of Palmer as a place where criminalabortion can be practiced with such appalling results.
On Jan. 31st Lord Hewart passed a sentence ofseven years penal servitude and ordered Palmer topay the costs of the prosecution. Persons, said theLord Chief Justice, to whom clients resort for thepurpose of illegal operations, undoubtedly subjectthose clients to very grave risks ; "it is rightthat all of them, wherever they may be inthis country, should understand that they incurgrave risks themselves."
Pasteurised Mil7L.In 1922 Parliament forbade the offer for sale and
the advertisement or description of milk as " pasteur-ised milk," except under licence given by the Ministerof Health or granted with his authority under a.
statutory order. Licences could be granted on termsand conditions prescribed by such order. The subse-quent Milk (Special Designations) Order of 1923 dealtinter alia with pasteurised milk and enacted as one ofthe conditions that, on a sample taken after pasteurisa-tion and before delivery to the customer, the milkshould be found to contain (in samples taken afterthe year 1923) not more than 100,000 bacteria percubic centimetre. Our contemporary, the MedicalOfficer, reports what is perhaps the first of the prose-cutions for breach of this condition. A Wandsworthfirm was prosecuted at the Kensington Petty Sessions.for selling " pasteurised " milk not of the stipulatedstatutory standard, a sample (submitted to the ClinicalResearch Association) having shown bacteria to thenumber of 323,333 per cubic centimetre. It wasstated for the prosecution that two other samplestaken might equally have formed the subject ofproceedings, and that the lids of the churns from whichthe samples were taken did not satisfactorily excluderain and dust. The magistrates found the offencesproved and fined the defendant firm (which had notappeared) 25 and £ 10 10s. costs. There was a secondsummons on which a further fine of £ 3 was imposed.This was for selling in Kensington without a Kensing-ton licence in breach of a condition specified in thelicence. The firm had a, Wandsworth licence forselling pasteurised milk, but this did not authorisesale outside the Wandsworth area except by way ofwholesale distribution.
Death from Borax Poisoning.Recently at an inquest at Luton on the death of an
infant, IS days old, Dr. J. Birch stated that the post-mortem examination showed death to be due to boraxpoisoning. The symptoms, he said, could have arisenfrom the use of honey and borax or glycerine andborax, a jar of which was produced in court. Dr.Birch criticised the use of this substance as dangerous.especially when dispensed as a remedy for thrush-usually administered by smearing it on the gums ofthe infant. He stated that a quarter of the amount-given to this baby had been known to be fatal toadults. He had known the danger of this preparationall his professional life and had always forbidden its.use. He considered it ought not to be given in theBritish Pharmacopoeia in its present strength.
Injury Caused by Hair-dye.Actions are not infrequently brought against hair-
dressers for damages for dermatitis caused by theapplication of hair-dye. They are based uponallegations that the hairdresser has been negligent,or alternatively upon breach of contract andwarranty. - Such an action was lately brought against,an Oxford-street hairdresser who appears to haveemployed a dye containing 30 per cent. of para-phenylene diamine. His practice was to exhibit aprinted notice disclaiming liability for the ill-effectsof his hair-dyes ; the notice stated that about twopersons in a thousand suffer ill-effects ; "as it is
impossible to know these few without a test, we arewilling to give this free trial on the customer’s ownresponsibility." The plaintiff, who wanted her hairdved blue-black like that of a friend of hers who hadrecently been so treated, was given a preliminary test.Dye was applied to a patch of skin behind the ear-
256
the size of a sixpence. The result, according to theplaintiff, was dermatitis of the scalp, inflammation ofthe left ear and of the neck and chest, swelling of theeyelid, insomnia, shock, and nervousness. Mr. JusticeHorridge left it to the jury to say whether, in all thecircumstances of the case, the plaintiff had received.adequate warning of the risk she ran in having thetest applied ; if she had had such a warning, theyshould find a verdict for the defendant. This theyproceeded to do forthwith, without leaving the box,.and judgment was entered for the hairdresser withcosts. TI_lH, - T..+;^? ITT-- 741, 2, .",. z
Heaun V7- J’LGJL’LGG
The learned Recorder of Chichester, at a lecturegiven to the Royal Institute of Public Health whichwas reported in THE LANCET last week, gave hisopinion that no change should be made in the legalrule which requires a doctor to disclose confidentialdetails concerning his patients. Lord Justice Atkin,however, expressed a different view at the close of thelecture ; he frankly stated that in some cases-notablythose connected with venereal disease-the claims ofpublic health far outweighed those of justice, and hefavoured a change in the law. The Lord Justiceprovided a fresh argument in this controversy byreferring to the secrecy with which-certain evidence ofofficial matters is treated. The solicitor’s privilege isdefended because it is in the interests of the adminis-tration of justice ; the doctor’s privilege is refusedbecause it conflicts with the administration of justice ;and yet the courts allow facts to be withheld-if,for instance, they concern the technical details of theequipment of our fighting services-without anyreference to the administration of justice whatsoever.In the past few weeks there has been a prosecutionunder the Official Secrets Act of two spies, who havereceived severe sentences ; part of the evidence wasgiven behind locked doors. There has also been anapplication in the police-court concerning the owner-ship of certain naval documents, and again theproceedings were partly carried on in camera. Mayit not be just as much to the interest of the Stateto withhold facts dealing with a man’s healthas to withhold facts dealing with the constructionof a submarine ? ?
SOUTH AFRICA.
(FROM A CORRESPONDENT.)
Dengue in Durban.DURING the first half of 1927 Durban suffered from
a remarkable epidemic of dengue fever, the numberof cases in the town and its vicinity being estimated atabout 50,000. At the request of the town councilDr. A. J. Orenstein, of Johannesburg, has submitteda report on the measures that should be taken toeliminate mosquito-breeding and thus prevent thedisease. In this report he says that it is now estab-lished with reasonable certitude that dengue istransmitted by Aedes egypti, more commonly known asStegomyia fasciata. This mosquito invariably breedsin collections of water near human habitations, itsflight is very limited, and it may safely be said thatunder ordinary circumstances it does not travelmore than 100 yards. The larvae are most commonlyfound in artificial receptacles, both indoors andoutdoors, and will develop in very small collections ofwater—e.g., in tin cans or broken bottles, in ewers ofwater in unused guest rooms, in water-tanks, water-barrels, and holes in trees. The larvae can remainsubmerged for several hours, and consequently maybe difficult to detect in fairly large collections of water,such as rain-water tanks. The eggs are very resistantto unfavourable conditions and may remain dry formonths and yet, when placed in water, hatch outhealthy mosquitoes. The adult mosquito will, underfavourable circumstances, survive for several weeks.
It used to be considered, says Dr. Orenstein, thatCulex fatigurts transmitted dengue, but experimentalwork seems to have disposed of this theory. Stegomyia
is almost certainly the sole danger, and its habits ofbreeding are consequently of great importance inconsidering the preventive measures. As it appearsthat a very large portion of the European populationof Durban and its vicinity were attacked by dengueduring the first half of 1927 there is good reason tobelieve that an outbreak on a large scale is improbablein the near future among the European population,inasmuch as it has been shown by Siler, Hall, andHitchens that the disease conferred immunity in58 per cent. of cases, and modified towards mildnesssubsequent attacks in the remainder. An outbreakmight, however, occur among the native and colouredpopulation, who apparently were not affected as muchas the European population by the last epidemic, andan outbreak of minor magnitude might occur amongthe European population not attacked in the lastepidemic.
Dr. Orenstein does not think that dengue should bemade a notifiable disease, but he suggests that themedical officer of health should circularise the medical
! practitioners of Durban to ensure (a) that all casesshould, for the first three to five days of their illness,be carefully protected by mosquito nets; and (b) thatthe houses of such cases be searched for adultmosquitoes and for mosquito-breeding, with a view toits elimination. He recommends that the municipalityshould offer to provide on loan mosquito nets forpatients and for the personnel of the mosquito search,for " Protection of the sporadic cases against mosquitobites ... is the best and most promising measure ofpreventing an epidemic of dengue."
It is suggested that the following amendments bemade in the public health regulations :-
(a) No tanks, wells, barrels or receptacles of any kind forthe collection or storage of water shall be permitted exceptin those districts which are without a public water-supply.When such tanks, wells, barrels, or other receptacles for thecollection or storage of water are permitted, they shall bemade mosquito-proof to the satisfaction of the medicalofficer of health. Wells, where permitted, must be fittedwith an approved pump.
(b) The throwing or keeping of tins, bottles, brokencrockery, or any other object that may hold water andthereby become a breeding-place for mosquitoes, in anystreet, yard, alleyway, or any premises or property, whetheroccupied or unoccupied, constitutes an oftence.
(c) All premises, whether occupied or unoccupied, must bekept in such a condition as to prevent mosquito-breeding,and the medical officer of health may give notice to theowner or occupier of such premises requiring him to correct,within a definite time-limit, the conditions as specified inthe notice. Failure to carry out the instructions containedin the notice shall constitute an offence.
(d) Roof gutters shall be so planned and constructed as tobe self-draining and remain dry between rainfalls. Upondue notice from the medical officer of health, which shallspecify a time-limit, the owner or occupier of the premisesshall remove or repair roof gutters which hold water andmight give rise to mosquito-breeding.
(e) If any owner or occupier refuses to carry out themeasures specified in any notice under these regulations, orfails to do so within the time-limit imposed, the localauthority may, by persons duly authorised thereto, carryout such measures. The costs incurred in so doing shall berecoverable by the local authority from the person uponwhom the notice was served.
Dr. Orenstein recommends that special inspectorsbe detailed for work against stegomyia ; it would betheir duty systematically to inspect premises forbreeding-places, especially during the warm season.The large swampy areas in the vicinity of Durbanpresent difficult problems of mosquito control.Without more data Dr. Orenstein is not prepared tosuggest definite methods of permanent control, butproposes an experiment on a small scale in two areaswhere cattle could be kept out by fencing, sunflowerscould be planted, and collecting pools could be arrangedat the lowest point, with clear banks, for any excessivewater. This might, he thinks, lower the surface watersufficiently to diminish mosquito-breeding veryconsiderably. At present larvae are controlled inswamps and ditches by means of crude oil, but inseveral instances he found larvae where oil had beenrecently applied, this being due either to the oil
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